Curriculum

Clinical Training Program

Georgetown's fellowship training program is accredited by the Accreditation Council for Graduate Medical Education (ACGME) for subspecialty training as a combined hematology/oncology program and offers clinical training to prepare fellows for certification:

Three-year program leading to eligibility for hematology-oncology subspecialty certifying examination.

The first year of clinical training for medical oncology and hematology fellows is focused on an in-depth clinical experience that integrates the fellows into the primary care of the division's patients. The faculty member shares in caring for each patient and provides year-to-year continuity in managing the patient.

The weekly outpatient schedule is divided into disease-specific clinics, which are attended by faculty with expertise in these diseases. The outpatient clinics are a major focus for clinical teaching. During patient visits, faculty members and fellows review patient management, disease response, and treatment selection. An integrated approach to patient management is stressed, including coordination of care with research nurses, nurse practitioners, social workers, and the psychiatry liaison service.

Combined Hematology and Oncology Program: Year I and II - Medical Oncology and Hematology, Year III - Research projects and outpatient continuity clinics

Each Fellow elects whether to spend the third year at a clinical or laboratory research project. Fellows who elect a laboratory project will have a one-half day clinic as continuity clinic at the VA for the 12 months and another one-half day continuity clinic at the Lombardi outpatient clinic. Fellows who elect clinical research will have two half-day clinics related to their clinical research at Lombardi Clinic and one half-day continuity clinic each at the VAH and GUH. During the last several years, Fellows have spent the third year in these sectors: laboratory research, Clinical Breast Cancer research, Development Therapeutic program, GI program, and Coagulation.

Clinical Responsibilities

All first and second year Fellows spend 3 to 5 months each year on the MedStar Georgetown University Hospital hematology/oncology inpatient unit. The Fellows supervise the house staff and take responsibility for ordering and overseeing chemotherapy administration on the inpatient service. Fellows participate daily in formal teaching rounds with the attending physician of the month. The oncology consult service is covered by the Oncology Fellow on the inpatient service, while the hematology consult service is assigned to one of the two hematology fellows on the inpatient service. The fellows continue to have one half-day clinic while on the hematology consult service. During the inpatient rotation fellows are excused from outpatient assignments, except the continuity clinic, and the hematology consult fellow as noted above The inpatient medical team also integrates services with research nurses, social workers, and members of the pain control and psychiatry service staffs.

Fellows participate in follow-up outpatient clinics. The clinics are divided into disease-specific sessions. Fellows are responsible for the evaluation and work-up of all new patients, as well as seeing established patients for chemotherapy and follow-up.

On Call Rotation

First and second year Fellows are responsible to take first call during evening hours and weekends. The faculty member who is the month's ward attending provides backup. Fellows take calls from home. When Fellows are not on call at night or over the weekend, they have no responsibilities for patient coverage. Third year Fellows will have to cover the Veterans Affairs Medical Center three to four weekends/year.

Blood Services Interaction

Fellows rotate through the University Hospital's Blood Bank Blood Donor Service and Hemapheresis Unit. The Blood Bank is accredited by the American Association of Blood Banks and performs a full range of services, including irradiation of compounds on-site, antibody identification, and red cell-washing using a fully computerized system. The Blood Donor Service is the only full-service American Red Cross blood collection site in the country operating within a medical center. It offers autologous- and directed-donor collection, as well as platelets, pheresis, and special collections. The Hemapheresis Unit collects stem cells for transplant and provides therapeutic plasmapheresis for a wide range of diseases.

Special Training Opportunities

First Year Fellows rotate at the Washington VA Medical Center, a general oncology service both at the inpatient and outpatient services. Second Year Fellows rotate for one month on the hematology inpatient service at the Washington Hospital Center and two months on the BMT service at the National Institute of Health.

Electives
Second Year fellows elective rotations are available in such services as radiation medicine, gynecologic oncology, pediatric hematology/oncology, hematology electives (pheresis, blood banking, coagulations) and pathology.

Clinical Coagulations Rotation
Second Year Fellows participate in clinical rotations in coagulation, blood banking and heresies. Training in coagulation laboratory is oriented toward clinical problem solving of a full range of coagulation disorders. They will have two months of experience in the Bone Marrow Transplantation program in years. This rotation entails extensive training in both allogenic and autologous bone marrow transplantation for hematologic malignancies as well as for solid tumors.

Blood Services Interaction
Second Year Fellows rotate through the University Hospital's Blood Bank Blood Donor Service, and Hemapheresis Unit. The Blood Bank is accredited by the American Association of Blood Banks and performs a full range of services, including irradiation of compounds on-site, antibody identification, and red cell washing using a fully computerized system. The Blood Donor Service is the only full-service American Red Cross blood collection site in the country operating within a medical center. It offers autologous-and directed donor collection, as well as platelets, pheresis, and special collections. The hemapheresis Unit collects stem cells for transplant and provides therapeutic plasmapheresis for a wide range of diseases.

Research Training

Clinical Research

The division offers a series of specialized senior fellowships that provide for fellows who demonstrate research promise and accomplishment with support beyond the period required for board certification. The division has major clinical research programs in breast cancer, gastrointestinal cancer, prostate cancer, developmental therapeutics and hematologic malignancies. The division participants in cooperative studies with Cancer and Leukemia Group B (CALGB) and the National Surgical Adjuvant Bowel and Breast Program (NSABP), among other groups.

Developmental Therapeutics Fellowship

Georgetown offers a one- to two-year Developmental Therapeutics Fellowship Program designed to train hematologists and oncologists for careers in academic clinical research, the pharmaceutical industry, or regulatory agencies.

The fellowship focuses on the early clinical trials of novel anti-cancer agents with an emphasis on clinical pharmacology and the regulatory requirements associated with new drug development. At the start of the program, fellows are given primary responsibility for one or two early clinical trials and are expected to complete, analyze, and publish the study during their fellowship. Training is coordinated with the Division of Clinical Pharmacology in the Department of Pharmacology and includes clinical trials methodology, research ethics, biostatistics, analytical drug assays, pharmacology, and pharmacokinetics. Course work at Georgetown or at the Food and Drug Administration (FDA) Staff College is encouraged. Fellows complete a three-month rotation at the FDA.

Cancer Control and Prevention Fellowship

The Georgetown Lombardi Cancer Prevention and Control Research Program Provides training in (1) molecular epidemiology research, where biological markers of risk and prognostic significance are identified and tested; (2) bio-behavioral research that aims to translate advances in molecular biology and epidemiology into state-of-the-art cancer prevention and control interventions; and (3) cancer geriatrics research that encompasses molecular epidemiology, health behavior, and health services research issues for the majority of most cancer patients who are elderly.

This program also provides opportunities for training through participation in multi-institutional research projects focusing on the prevention and control needs of low-income and medically underserved populations. For example, Georgetown Lombardi is collaborating with Johns Hopkins University to promote cancer screening and tobacco control among East Baltimore community organizations that already provide their low-income, black and white members an opportunity to buy food through a national food and community-service program. Georgetown Lombardi also is collaborating with the Washington Hospital Center to promote cancer screening and dietary modification to District of Columbia participants of the same program. Another national study based at Georgetown Lombardi is looking at the cost-effectiveness of breast-conserving surgery, with and without radiation therapy, versus modified radical mastectomy for early stage breast cancer among black and non white women age 65 and above.

Teaching & Career Development

Conferences

In addition to the standard course of research and clinical experience, a distinctive feature of Georgetown's fellowship program is an integrated program of lectures-and teaching opportunities. The conferences are an important teaching venue, and Fellows actively participate.

The Division of Hematology/Oncology has several weekly conferences focused on both patient care and research interactions. Fellows actively participate in these conferences, which are one of the major activities of the teaching program:

Morning Report: Every Monday morning the entire group of faculty and fellows attend a 40 minute case presentation or literature review provided by one of the Fellows. The last 15 minutes are for Board Review of multiple choice questions.

Hematologic Oncology Conference: The Hematologic Oncology faculty and the Hematopathology faculty gather once a week on Tuesday’s to review the status of complex patients including their pathology, treatment plans and entry to research studies.

Gastrointestinal Oncology Conference: This is a weekly conference with members of the Departments of Radiology and Surgery and the Division of Gastroenterology to review management of patients who are beginning their therapy at Georgetown.

Pathology Conference: The Department of Pathology conducts a weekly slide review for the division. This conference is also attended by faculty from the Department of Radiation Medicine. The conference is designed to familiarize fellows with histologic patterns typical of malignant diseases and to prepare them for the pathology section of the board examination in medical oncology.

Pulmonary Conference: Weekly the Divisions of Pulmonary Medicine and Hematology/Oncology meet to discuss management issues of common interest. This is a conference that reviews many of the patients with lung cancer.

Cancer Center Research Conference: The Cancer Center sponsors a weekly research seminar given by a speaker from the Cancer Center, or from another institution on a topic relevant to research at the cancer center.

Brain Tumor Conference: A weekly multidisciplinary brain tumor conference held Friday and attended by members of Oncology, Neurosurgery, Radiation Oncology and Radiology departments.

Oncology/Hematology Journal Club: Held twice monthly on Mondays at 12:30 pm. Presentations include clinical and basic science topics from recent publications, selected by fellows in conjunction with the fellows.

Coagulation Teleconference: held once monthly between GUH, GWH, NCI, and WHC.

Lymphoma Teleconference: Held once monthly between GUH, WHC, GWH, and NCI.

Hematology Research Conference: Held weekly on Thursdays at 12:30 pm. Review of current protocols and patients accrual. Also lectures on hematology topics are provided frequently by members of the division.

Lombardi Grand Ground: Held first Friday of each month. Prominent speakers from different centers are invited.

Tuesday Core lecture Series: Core lectures at 8:00am cover the whole curriculum are provided by members of the cancer center.

We encourage second-year Fellows to attend scientific and medical conferences in the Washington/Baltimore metropolitan area. In addition, the division supports travel to one national meeting during the second and third fellowship years. Most Fellows chose to attend one of the annual meetings of a major national society, such as the American Society of Clinical Oncology or the American Society of Hematology.

Teaching Opportunities

Fellows provide supervision and instruction to residents and medical students who rotate through the outpatient clinic. Fourth year medical students are assigned to the outpatient department throughout the year. Each student is assigned to a Fellow for clinical supervision and teaching.